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NCCN Guidelines for Patients


Esophageal Cancer, Version 1.2016


Treatment guide: Squamous cell carcinoma Invasive cancer

This section presents the treatment options for

invasive cancer. These cancers have grown beyond

the second layer of the esophageal wall (submucosa).

There may be cancer in nearby Iymph nodes but

not in distant sites. Options range from the start of

treatment to follow-up care on pages 56 and 57.

TNM scores of invasive cancers are listed in Guide 7.

Cancer in nearby lymph nodes is represented by “N+”

since the number of lymph nodes with cancer can’t be

known before surgery.

Guide 7

lists options for initial treatment. Surgery

may be a treatment option for these cancers. Your

doctor will assess if you are able to undergo surgery

by testing your lungs, heart, and nutritional intake.

Your doctor will also assess if chemoradiation or

chemotherapy would do more help than harm.

Approved and agree to surgery

If you can have surgery, your treatment options likely

depend on where the tumor is. There are two options

if the tumor isn’t in the neck area. An esophagectomy

may be done when surgery is likely to remove all the

cancer. The second option is chemoradiation with

the intent to have surgery afterward. This is called

preoperative chemoradiation.

The recommended chemotherapy regimens for

preoperative chemoradiation are:

Preferred regimens

• Paclitaxel and carboplatin

• Cisplatin and 5-FU (or capecitabine)

• Oxaliplatin and 5-FU (or capecitabine)

Other regimens

• Irinotecan and cisplatin

• Paclitaxel and 5-FU (or capecitabine).

Doctors call chemoradiation given to try to cure

cancer “definitive chemoradiation.” It is an option for

tumors in the neck area and T4b tumors. Even if you

are healthy enough for surgery, these tumors can’t be

first treated with surgery. Chemotherapy is another

option for T4b tumors that have invaded the trachea,

heart, or major blood vessels.

The recommended chemotherapy regimens for

definitive chemoradiation are:

Preferred regimens

• Cisplatin and 5-FU (or capecitabine)

• Oxaliplatin and 5-FU (or capecitabine)

• Paclitaxel and carboplatin

Other regimens

• Cisplatin with docetaxel or paclitaxel

• Irinotecan and cisplatin

• Paclitaxel and fluoropyrimidine (5-FU or


Not approved or decline surgery

Guide 7 also lists options for people unable to have

surgery. Chemoradiation to try to cure the cancer is

an option if chemotherapy will do more good than

harm. Chemotherapy regimens are listed above.

If you are unable to have chemotherapy, supportive

care is advised. This may include radiation therapy

to prevent or treat symptoms caused by cancer.

Supportive care is addressed later in this chapter in

the section

Advanced cancer